|
| Article Access Statistics | | | Viewed | 935 | | | Printed | 42 | | | Emailed | 1 | | | PDF Downloaded | 0 | | | Comments | [Add] | | | Cited by others | 2 | | |
|
Click on image for details.
|
|
|
|
ORIGINAL CONTRIBUTION |
|
|
|
| Year : 1997 | Volume
: 51
| Issue : 5 | Page : 161-163 |
| |
HIV associated chronic atypical osteomyelitis by mycobacterium fortuitum - Chelonae group - A case report
DV Gadre
Department of Microbiology UCMS and - GTB Hospital. Delhi-110 095, India
Correspondence Address:
D V Gadre
Department of Microbiology UCMS and - GTB Hospital. Delhi-110 095
India
PMID: 9355720
How to cite this article:
Gadre D V. HIV associated chronic atypical osteomyelitis by mycobacterium fortuitum - Chelonae group - A case report. Indian J Med Sci 1997;51:161-3 |
With the advent of AIDS, tubercuosis an endemic disease has changed to an epidemic one worldwide. Human Immunodeficiency virus infection predominently affects 15 to 49 years old age group. Its impact is greatest in developing countries, where the prevalence of tuberculosis is also high in this age group. In early 1992, World Health Organisation estimated that at leas ( 9-11 million adults and 1 million children have been infected with HIV throughout the world, 85% of them in developing countries. [1] Commonly M. tuberculosis, M. avium intracellulare are the causative agents of pulmonary, extra-pulmonary and disseminated infection seen in AIDS patients. Several Non-Tuberculous Mycobacteria (NTM) have been detected with increasing frequency from patients with immunodysfunction. [2] M. fortuitum-chelonae is a group of rapid growers, which are characterised by their ability to grow in 3 to 5 days. They are usually resistant to Paraamino Salicilic acid, Streptomycin and Isoniazid but are susceptible to amikacin, cefotaxin and often to tetracycline. [3] I present here a case of HIV associated chronic atypical osteomylitis in which M. fortuitum-chelonae . were repeatedly isolated in culture.
| ¤ Case Report | |  |
A 32 year old man presented with pain and swelling in the right leg for two years. The patient had low grade fever for 2 months associated with malaise, loss of appetite and loss of weight. There was no history of acute febrile illness, discharge from leg and no history of recurrent chest or urinary infection. History of contact, both heterosexual as well as homosexual 4 years ago, was forthcoming.
On examinations : The patient was febrile, no significant local or regional lymphadenopathy. Locally there was irregular prominence of the anteromedial border of the right tibia. This was not associated with any abnormal pigmentation, discharging sinus or dilated vein. Bony thickening was palpable along the entire length of tibia and was tender with no local rise of temperature. There was no limitation of knee and ankle movements.
Investigations : The haemogram was within normal limits and ESR was 18 mm at the end of first hour. X-ray chest appeared normal: X-ray right tibia revealed an osteolytic lesion along the entire extent of tibia, with irregular thickening of the posterior cortex. Blood culture, sputum and aspirate from core biopsy showed no growth of pyogenic bacteria. The aspirate from the core biopsy was examined by Ziehl Neelsen and fluorescent staining for Acid Fast Bacilli and was positive. Cultures which were put up in duplicate on Lowenstein Jenson's slopes (LJ slopes) (LJ slopes) showed rapidly growing mycobacteria within a week. The isolate was identified on the basis of rate of growth, colony morphology and biochemical tests as M. fortuitum-chelonae group. [4]
Three consecutive samples taken at the interval of one week showed growth of M. fortuitumchelonae in culture. Repeated isolation confirmed the diagnosis of M. fortuitum-chelonae, however the drug susceptibility and further identification of subspecies could not be done.
The sputum sample of the patient was examined for AFB by direct examination and culture, was negative for AFB. The patient had not been BCG vaccinated. There was no scar of BCG vaccination. However Monteux testing was not done in this case. Fungi were not detected both by KOH examination and culture. The histopathology results of the core biopsy were consistent with chronic osteomyelitis without any granuloma. Serology : ELISA for HIV was strongly reactive. Similarly ELISA for IgG antibodies to Mycobacteria was positive (Omega Diagnostics). Western blot for antibodies to HIV-I was indeterminate initially but when repeated after three months was positive. Standard test for Syphilis (VDRL) and widal test were negative. patient was put on Isoniazid, Rifampicin, E'thambutol and pyrazinamic. Ciproflox was given initially for two weeks alongwith ATT which was given for six months. Currently the patient is under a follow up and has shown remarkable improvement.
| ¤ Discussion | | |
Recently the increase in the number of infections by non tuberculous mycobacteria including M. fortuitum-chelonae in the United States has been described. [5] M. fortui,um-chelonae cause mainly soft tissue abscesses. [6] Wound infections of the sternum after open heart surgery caused by M. Cheloni has been reported . [7] There are reports of HIV involving musculo skeletal system. [8],[9]
The HIV associated with disseminated infections with M. avium intracellure, M. Kansasii [10] are described, however so far there are a few reports of atypical osteomyelitis due to M. fortuitum-chelonae group. Tuberculosis is the most common opportunisitic infection seen in AIDS patients; the former condition is curable and preventable. Early detection of TB infection is, parammount in dividuals with HIV infection. [11] Therefore all HIV infected patients should be tested for tuberculosis and viceversa. This approach could minimize the devastating interaction between the agents of these two diseases.
| ¤ Summary | | |
In developing countries where tuberculosis is endemic, the HIV patients have tuberculosis as one of the major opportunistic infections. Commonly M. tubberculosis, M. Avium-intracellure are the causative agents of pulmonary, extrapulmonary and disseminated infection in AIDS patients. Here is a report of a 32 year old HIV positive male who presented as chronic atypical osteomyelitis of right tibia. Core biopsy confirmed the diagnosis by hislopathology, direct microscopyy and culture of M. fortuitumchelonae group: identified by the biochemical tests. TB IgG ELISA was strongly positive. ELISA for HIV antibodies was reactive on three occasions. Westernblot was positive for HIV-I antibodies. Patient responded well to ciproflox and antitubercular treatment and is currently under a follow up.
| ¤ References | | |
| 1. | Reviglione MC, Narain JP, Kochi A. HIB associated tuberculosis in developing countries. Bulle WHO OMS 1992:70:515-524.  |
| 2. | Baron EJ, Peterson LR, Finegold SM. Bailey and Scott's Diagnostic Microbiology pp 590-633. 9th ed St. Louis, Mosby, 1994. |
| 3. | Wallace RJ, Swenson JM, Silcox VA. Spectrum of disease due to rapidly growing mycobacteria. Rev Infect Dis 1993;5:657-660. |
| 4. | Laidlaw M. Mycobacterium : Tuberculoid and leprosy bacilli. Mackie and Me Cartney's practical medical microbiology pp 417-424. 13th ed. New York : Churchill Livingstone, 1989 |
| 5. | Good RC. Isolation of nontuberculous mycobacteria in United States. J Infect Dis 1980;142:779-783. |
| 6. | Wolinsky E. Non tuberculous mycobacteria and associated diseases. Kubica GP, Wayne LG. The Mycobacteria a source book part B volume 15 pp 1141-1207. New York and Basel: Marcel Dekker, 1984. |
| 7. | Jaureguli L, Arbulu A, Wilson F. Osteomyelitis, pericarditis, Mediastivitis and vasculitis due to M. Chelonei. Am Rev Respi dis. 1977; 115:699-703. |
| 8. | Steinback LS, Tehranzadeh, J, Fleckenstein JL, Vanarthos WJ, Pais MJ. Human immunodeficiency virus infection : Musculoskeletal manifestations. Radiology 1993;186: 833-838. |
| 9. | Hughes RA, Rowe IF, Shanson D, Keat AC. Septic bone, joint and muscle lesions associated with human immunodeficiency virus infection. Br J Rheumatol 1992;6: 381-388. |
| 10. | Weinroth SE, Pincetl P, Tuazon CU. Disseminated mycobacterium kansassi infection presenting as pneumonia and ostenomyelitis of the skull in a patient with AIDS. Clin Infect Dis 1994;2:261-262. |
| 11. | Barnes PF, Qyoc HL, Davidson PT. Tuberculosis in patients with HIV Infection : Tuberculosis; Med clinics of North America 1993;77: 1369-1390. |
| This article has been cited by | | 1 |
Bone and joint involvement in human immunodeficiency virus infection |
|
| Temesgen, Z. | | Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca. 2005; 72(3): 177-182 | | [Pubmed] | | | 2 |
Urinary Mycobacterium fortuitum infection in an HIV-infected patient |
|
| Ersoz G, Kaya A, Cayan S, et al. | | AIDS. 2000; 14 (17): 2802-2803 | | [Pubmed] | |
|
|
|
|
|
